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The main indication for referring a child for paediatric barium meal is to investigate upper abdominal pain or vomiting, especially when there is bile-stained vomiting that raises the possibility of duodenal obstruction. Less common indications are duodenal malrotation and gastric hernias.
If the symptoms are acute, a mid-gut volvulus due to duodenal malrotation should be considered. This can be a medical emergency. An urgent opaque meal can be carried out for diagnosis. Gastric hernias are uncommon in children, but a barium meal study will show any abnormal position of the stomach.
A barium follow-through examination is only needed if there is suspicion of small bowel pathology distal to the duodenojejunal junction.
Suspicion of duodenal obstruction or malrotation.
Radiologists require a clearly written (legible) request with sufficient clinical information to ensure that the most appropriate examination is carried out. Not only does this enable the correct study to be carried out, it also enables provision of a meaningful report.
Suspicion of oesophageal, gastric or intestinal perforation.
Although barium will not damage the lungs if aspirated, it can cause granulomas if it enters the peritoneal cavity or mediastinum. If there is suspicion of oesophageal, gastric or intestinal perforation, this information should be specifically mentioned on the imaging request, as the radiologist might use water-soluble contrast media for at least the first part of the study.
If a computed tomography scan or ultrasound is also necessary as part of the investigation of the patient’s symptoms, they should be carried out first, as the barium ingested as part of a barium meal will interfere with interpretation of these other studies. The radiologist should be consulted to determine which study should come first and whether barium or another contrast agent should be used.
It is common for the patient’s bowel motions to be white after a Barium Meal and it can cause relative constipation so the patient should be encouraged to increase oral fluid and fibre intake.
Advise the parent that the child might suffer constipation and have white stool.
Last saved on 29 September 2016.
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